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So this amendment forbids any insurance policy that covers abortion from being available to anybody who gets any Federal subsidy money. It also forbids the public option from covering abortion, even if said public option is completely self-funding (and therefore isn't a Federal subsidy). It also forbids any policy in the "insurance exchange" from covering abortion, even if it's paid for entirely by the customer, without Federal subsidies.

However, private insurance companies (but not the public option) are allowed to make optional "abortion riders" available (but not in the exchange) for separate purchase (but not with Federal subsidies). Presumably an insurance company would be required to show that they get at least as much money in premiums for such riders as they spend on abortion services; if not, it could be argued that some of their Federal subsidy money was leaking over the border into abortions. In fact, they might even have to show that they make at least the same profit margin on the abortion rider as on their other policies; otherwise, again, Federal subsidy money is in some sense making it possible to pay for an abortion without hurting the profit margins.

Amusing image: the CEO of a major insurance company is called into a Congressional hearing to defend against charges from irate right-wingers that his company set premiums too low, or didn't deny enough claims.

Another puzzle: suppose you don't buy the optional "abortion rider" because you aren't sexually active at the moment. One giddy Saturday night, that changes, and you're afraid you might be pregnant. So you call your insurance company the next morning and say "I changed my mind; I do want the abortion rider." Insurance companies are forbidden to exclude people for "pre-existing conditions," so they have to sell you the rider. If so, then nobody would ever buy such a rider until they got pregnant and were considering abortion. Thus in order for premiums to pay for claims, the premiums for (say) six months would have to cover the cost of a single abortion, which means there's no advantage in buying one even if you do get pregnant. Therefore nobody will buy them, so nobody will sell them.

Or maybe the "no exclusion for pre-existing conditions" clause doesn't apply to optional riders. In which case insurance companies will still have departments charged with deciding whether to sell insurance to a particular customer, and they can still pick and choose their customers, selling insurance only to those who don't need it. The same mess we're in now.


I consider Stupak-Pitts yet more proof that politicians are willing to throw women under the bus. Fortunately my congressman (John Olver) voted against it, or I'd be camped out in front of his office right now in the pouring rain with a big home-made sign saying "JOHN OLVER HATES WOMEN."
politicians are willing to throw women under the bus.

Which is surprising, in a way, because women are a majority of the voters, and pro-choice people are also a majority of the voters. Pro-choice people are even a majority of Catholics. But they're not a majority of noisemakers on Capitol Hill.

Which actually suggests another reason for health-care reform to not kick in until 2013: if it kicked in earlier, and millions of people who currently have coverage for abortion services realize that they've lost that coverage, they might blame the R's at the voting booth. (Or they might blame the incumbents, regardless of party....)

More generally, if health-care reform is designed to fail, it's in the interest of all the current lawmakers to pass it so they can say they've done something, but not have it take effect until they've been through another election or two.